Basic Information
| Provider Information | |||||||||
| NPI: | 1417995200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGORY-LAINE | ||||||||
| FirstName: | GALE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 S MAIN ST | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780063321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302499995 | ||||||||
| FaxNumber: | 8302499868 | ||||||||
| Practice Location | |||||||||
| Address1: | 1421 S MAIN ST | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780063321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302499995 | ||||||||
| FaxNumber: | 8302499868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | K8182 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 150072003 | 05 | TX | MEDICAID | 150072001 | 05 | TX | MEDICAID | 8G2429 | 01 | TX | BCBS | OTHER |